Proof Of Teaching Experience - Oklahoma Department Of Education

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PROOF OF TEACHING EXPERIENCE
OUT-OF-STATE OR OKLAHOMA NONPUBLIC SCHOOLS
FOR OFFICIAL USE ONLY
Professional Standards Section, Room 212
2500 North Lincoln Boulevard
TEACHER NUMBER: _______________
Oklahoma City, OK 73105-4599
CREDENTIALS VERIFIED: __________
(Type or use a ball-point pen and press hard to make a clear copy.)
Teacher's Name: __________________________________________________________________________ Social Security Number: ___________ ________ ___________
Last
First
Middle
Maiden
Oklahoma school where currently employed: _________________________________ _______________________________________________________________________
(If applicable)
County
District
This record is for the Oklahoma State Board of Education to evaluate the experience of the person indicated above. In order to evaluate this experience ALL information must be
completed. This information will be used for determining salary increments, retirement credit, and/or for teacher certification.
NAME AND ADDRESS OF THE OUT-OF-STATE OR NONPUBLIC SCHOOL
ACCREDITATION STATUS:
Yes, the school was accredited for the years listed below.
Name of Accrediting Agency: _________________________________
___________________________________________________________________________
Name of School
No, the school was NOT accredited for the years listed below.
CERTIFICATION STATUS:
___________________________________________________________________________
Yes, the teacher held a valid state teaching credential during the years
Street Address
City
State
Zip Code
listed below.*
State: _______ Validity Dates: ___________ through ___________
_____________________________________________ ( _______ ) __________________
(Two Letter Code)
(MM/DD/YY)
(MM/DD/YY)
Print Name and Title of Certifying Official
Telephone Number
No, the teacher did NOT hold a valid teaching credential during the years
listed below.
USE A SEPARATE LINE FOR EACH SCHOOL YEAR AND COMPLETE ALL COLUMNS
Full Day
Actual
Dates of Service
or Fraction
Number of
Number of
Signature of Certifying Official
From
To
of Day
Days
Days in
School District or Institution
Position/Grade
State
County
SIGN EACH LINE
(Mo Day Yr)
(Mo Day Yr)
Employed
Employed
Full Year
*PLEASE INCLUDE A COPY OF YOUR OUT-OF-STATE TEACHING CERTIFICATE THAT WAS VALID DURING THE ABOVE DATES.
Per Oklahoma State Statute Title 70 § 18-114.7, teaching credit can be granted only for out-of-state teaching experience obtained in an accredited school system while the teacher was certified
to teach or who received special approval to teach by the state's licensing authority. For the purpose of state salary increments and retirement, no teacher shall be granted credit for more than
five years of out-of-state teaching experience as a certified teacher.
January 2015
Send one copy to School Personnel Records and one copy to the Professional Standards Section.

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